Healthcare Provider Details

I. General information

NPI: 1528971405
Provider Name (Legal Business Name): ELITE NEUROSPINE & ORTHOREHAB P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27207 LAHSER RD STE 108
SOUTHFIELD MI
48034-8470
US

IV. Provider business mailing address

27207 LAHSER RD STE 108
SOUTHFIELD MI
48034-8470
US

V. Phone/Fax

Practice location:
  • Phone: 201-312-2412
  • Fax:
Mailing address:
  • Phone: 201-312-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: YAN M LI
Title or Position: DIRECTOR
Credential: MD
Phone: 201-312-2412